Cost-effectiveness of revascularization for limb preservation in patients with marginal functional status

Annals of Vascular Surgery
Neal R BarshesMichael Belkin

Abstract

Revascularization and limb salvage attempts are often offered to patients with foot wounds and chronic limb ischemia who are thought to be good-risk candidates, but some skepticism remains about the utility of these efforts for elderly patients with marginal functional status. We sought to determine whether limb preservation efforts in this population could be justified from a patient-centered, cost-effectiveness perspective. A probabilistic Markov model was used to simulate the clinical outcomes, health utilities, and costs over a 10-year period with various management strategies. Clinical parameter estimates were obtained from previous clinical trials and large observational series. Cost estimates were obtained from cost literature and also a single-center study that reviewed total costs accumulated (including secondary amputations, wound care, outpatient nursing care, and nursing home costs). Cost (in 2011 U.S. dollars) per year of ambulation (with limb preservation or with a prosthesis after amputation) was the primary measure of cost-effectiveness. The total 10-year costs of revascularization--either endovascular or surgical--were lower than the costs of either local wound care alone or primary amputation. Revascularizatio...Continue Reading

References

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Citations

Aug 19, 2016·Plastic and Reconstructive Surgery·Jonathan I Leckenby, Adriaan O Grobbelaar
Jul 12, 2018·Current Cardiology Reports·Eric W RudofkerEhrin J Armstrong
Sep 10, 2020·The International Journal of Angiology : Official Publication of the International College of Angiology, Inc·Tanner I KimBauer E Sumpio

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